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Diaphragm Pacing?
I am curious at to anyone else has experienced this..I know about that it does happen and I have did lots of research on here and on the web but I haven't found anything that is like my situation and either have my drs so I thought I would try here.
I am both atrial and ventricular paced and have been for awhile. This year I had 3 pocket revisions due to either pm or lead moving. After the revisions I started having the horrible beating/kicking in the bottom of my chest/diaphragm area. I only feel it if I'm up moving, if i'm sitting on the couch I'm fine. My dr felt it and said yes that is coming straight from your diaphragm, well when they did xrays it doesn't look like the V lead has moved. So they are completely lost as to what is causing this. It has gone on so long it makes me very nauseous all the time and I have lost quite a bit of weight, I am down to 91lbs now. They say the pm and leads look good but then what is causing the symptoms? I also get very short of breath, hiccups, and dizzy when I'm up moving for awhile.
My dr has now referred me to the mayo clinic to try to find answers but thought I would look here to see if anyone has had this also happen to them.
Any thoughts are appreciated!
4 Comments
Sounds like
by pioxen - 2014-08-26 10:08:14
Sounds like the lead may be resting on a nerve then. It may just be something you're going to live with for awhile. If this wasn't occurring before you got the new pacer, then you can safely assume it's the pacer causing it. What you can take away from this is...it's nothing life threatening, just inconvenient. I get small episodes with mine, but i ignore it.
CRT and diaphram
by pioxen - 2014-08-26 10:08:51
If a high-amplitude pacing pulse stimulates the diaphragm directly or via the right or left phrenic nerve, the pulse can trigger an involuntary contraction of the
diaphragm (hiccup reflex), which can be bothersome for some patients. The most common reason for diaphragm stimulation in CRT patients occurs when pacing is
delivered by a left ventricular (LV) pacing lead positioned adjacent to the left phrenic nerve, which passes directly over the heartâs left ventricle.
In some device families, diaphragm stimulation is more likely to happen during daily Lead Impedance measurement tests because the temporary pacing
amplitude used during the test may be significantly higher than the permanent amplitude at which the device normally provides pacing. It is (usually) recommended that patients be tested for diaphragm stimulation during the implant procedure by pacing the LV lead through the device at a high amplitude
(7.5 V) and adjusting the lead position as necessary.
If diaphragm stimulation occurs at the same time each day, it may be attributed to daily lead impedance measurement tests. The following programming options
may be considered to mitigate diaphragm stimulation resulting from Daily Measurements:
Reprogram the LV pace vector.
This may alter the pacing energy
pathway such that diaphragm stimulation can be minimized or eliminated.
Program the LV Daily Lead Impedance test to Off.
If diaphragm stimulation occurs only during Daily
Measurements, the feature can be programmed to Off.
If diaphragm stimulation occurs during normal LV pacing, the physician may consider non-invasive programming options such as selecting a new LV pace
vector or reducing the LV pacing amplitude, if clinically appropriate
Keep Looking For An Answer
by Many Blessings - 2014-08-31 01:08:41
Hi Daisy,
Keep searching for an answer. Since you have lost so much weight and are down to only 91 pounds, this is not something you can just ignore and get used to!
I know it's not the best option, but if they have tried absolutely everything else, have they considered relocating your leads. Again, this being the absolute last option.
Also, is there any kind of medication that you can take or procedure that you can have done to make you less sensitive to the diaphragmatic pacing, or at least will get rid of the nausea until they can figure things out? Maybe someone out here can make suggestions for you there.
I'm so sorry you're going through this. I had it for a day or so after I had my CRT put in, but luckily they got it figured out with a few adjustments. I do remember them telling me that sometimes, they can't get it figured out, and have to relocate the leads if the patient can't get used to it.
I still get it every once in awhile now, but it is very minimal in severity in comparison to when I first had it when I was in the hospital. I'm assuming yours is like mine was at first, where you can actually see that whole area "kicking", fluttering and jerking. It isn't fun, and I'm so sorry you've have to deal with this for all of this time.
I hope so much, that you can find someone that can give you the answer. Hopefully, someone out here will come up with something that you haven't tried yet.
Best wishes to you!
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No LV for me
by daisy0388 - 2014-08-26 10:08:07
I only have the RV lead along with the atrial lead so that is what is puzzling them. They tried to turn down voltage to the both leads but it made me skip beats and felt like I was going to pass out so they turned it back up. Which is why i'm confused if I don't have a LV lead how can i be diaphragm pacing?